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Background

The pyogenic granuloma is a very common benign proliferation of capillary sized blood vessels. Its characteristic histologic appearance under the microscope leads to its other name, a lobular capillary hemangioma. This lesion are rapidly growing firm red papules that develop within weeks to months. The hands, face, and nasopharynx are favored locations. Disseminated cases may occur.

OUTLINE

Epidemiology  
Disease Associations  
Pathogenesis  
Laboratory/Radiologic/
Other Diagnostic Testing
 
Gross Appearance and Clinical Variants  
Histopathological Features and Variants  
Special Stains/
Immunohistochemistry/
Electron Microscopy
 
Differential Diagnosis  
Prognosis  
Treatment  
Commonly Used Terms  
Internet Links  

EPIDEMIOLOGY CHARACTERISTICS
SYNONYMS Lobular capillary hemangioma
Granulation tissue-like hemangioma
INCIDENCE Common

 

PATHOGENESIS CHARACTERIZATION
Trauma May precede some lesions

 

GROSS APPEARANCE/
CLINICAL VARIANTS
CHARACTERIZATION
General  
VARIANTS  
Granuloma gravidarum Associated with pregnancy
Epulis gravidarum Pregnancy associated tumors arising within the mouth
Satellite lesions with recurrence Arch Dermatol 1974;109:689-691
Smaller papules surrounding the original site
Usually younger patients on the upper trunk or shoulder

 

HISTOLOGICAL TYPES CHARACTERIZATION
General

A lobular proliferation of capillary sized vessels, sometimes compartmentalized

Overlying epidermis may be ulcerated but if intact, may form distinct collarettes around the vascular proliferation-this epidermis may be derived from follicular and eccrine ductal epithelium

VARIANTS  
Extramedullary hematopoiesis Am J Dermatopathol 2000;22:434-438
May be secondary to combination of homing and proliferation factors for stem cells
Extramedullary hematopoiesis in a pyogenic granuloma: a case report and review.

Vega Harring SM, Niyaz M, Okada S, Kudo M.

Department of Pathology, Tokyo Medical University, Tokyo, 160-8402, Japan.
J Cutan Pathol. 2004 Sep;31(8):555-7. Abstract quote  

Background: Extramedullary hematopoiesis in the adult life is usually associated with hematological disorders. It can often occur in several organs under certain pathological conditions, including the spleen, liver, and skin, which are normal sites during the embryogenesis, the skin being very uncommon.

Case report: A case of extramedullary hematopoiesis in a granuloma pyogenicum at the anterior aspect of the right thigh of a 31-year-old Japanese man is reported.

Results: Histologic examination revealed an ulcerated polypoid lesion composed of numerous newly formed capillaries and a myxoid edematous stroma. In addition, three islands of hematopoietic precursors were found.

Conclusions: This is, to our knowledge, the second case of extramedullary hematopoiesis in a granuloma pyogenicum. We believe that vascular lesions have potential to generate hematopoietic precursor cells; however, hematopoiesis will only occur in a setting of adequate microenvironment, as it occurs in the bone marrow.
Intravenous

Am J Surg Pathol 1979;3:221-22

Subcutaneous Arch Dermatol 1982;118:30-33

 

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES
Kaposi's sarcoma  
Bacillary angiomatosis  

 

PROGNOSIS AND TREATMENT CHARACTERIZATION
Treatment Surgical removal but many of these lesions regress spontaneously

Am J Surg Pathol 1980;4:470-479

Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Sixth Edition. WB Saunders 1999.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.


Commonly Used Terms

Basic Principles of Disease
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Commonly Used Terms
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Last Updated 8/24/2004

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